CKD-Anemia

Question 1

What levels of hemoglobin constitute anemia in males, females

Answer 1

less than 13.5 g/dl, less than 12 g/dl

Question 2

In what stages of CKD does anemia become more prevalent

Answer 2

Stage 3 and Stage 4

Question 3

How can CKD lead to anemia

Answer 3

decreased survival of RBCs, bleeding, declined EPO

Question 4

Which anemia is an iron deficiency, which anemia is folic acid and vitamin B12 deficiency

Answer 4

microlytic, macrolytic

Question 5

Where is erythropoietin synthesized, what does it do

Answer 5

kidney, initiates and stimulates the production of RBCs

Question 6

What happens to cells trying to become RBCs without EPO

Answer 6

Apoptosis

Question 7

What will replace EPO if it cannot be made in the body, how is it administered

Answer 7

Erythropoiesis Stimulating Agent (ESA), SC or IV

Question 8

When is an ESA initiated

Answer 8

less than 10 g/dL

Question 9

What is the goal of therapy

Answer 9

less than or equal to 11 g/dL

Question 10

When is the rise of Hb too much in ESA therapy, how is the dose reduced when this occurs

Answer 10

1 g/dL over 2 weeks, reduce by 25%

Question 11

T/F: The Black-Box Warning states there is an increase in the risk of death, myocardial infarction, stroke and other diseases if the lowest dose sufficient is not used

Answer 11

True

Question 12

How should Hb be monitored when patients are on this therapy

Answer 12

weekly, biweekly, monthly

Question 13

T/F: If hemoglobin does not respond by greater than 1 g/dl in 2 weeks, then you may increase the dose 50%

Answer 13

False: If hemoglobin does not respond by greater than 1g/dL in 4 weeks, then may increase dose by 25%

Question 14

When would increasing the dose become futile in a patient that is using ESA therapy

Answer 14

No adequate response over a 12 week period

Question 15

What are the ESA medications

Answer 15

Epoetin Alfa, Darbepoetin, Methoxy polyethylene glycol-epoetin beta

Question 16

What is the order of ESA medications by half-life, how often is each dosed

Answer 16

Epoetin Alfa/TIW, Darbopoetin/BIW (dialysis) or QIW (non-dialysis), methoxy polyethylene glycol-epoetin beta/BIW unitl Hb stable then double dose for every month dose

Question 17

When ESA therapy have resistance

Answer 17

Iron Deficiency, inflammation and infection, hyperparathyroidism, folic acid and vitamin B12 deficiency

Question 18

T/F: If a patient has a cancer and there is a potential cure for that cancer will not receive ESA therapy

Answer 18

True

Question 19

When uptitrating an ESA dose what is the minimum amount of time recommended to do so

Answer 19

4 weeks

Question 20

How is iron stored in the body

Answer 20

As ferritin

Question 21

What is the peptide that mainly regulates iron, what is its role due to a sickness

Answer 21

Hepcidin, inhibits iron availability for viruses and bacteria while also being a basis for anemia of chronic disease

Question 22

For all stages of CKD what should the TSAT be

Answer 22

20%-50%

Question 23

What should ferritin levels be if a patient is on hemodialysis, peritoneal dialysis or non-dialysis

Answer 23

greater than or equal to 200, greater than or equal to 100

Question 24

T/F: If a patient is on hemodialysis than they should recieve their iron by IV only

Answer 24

True

Question 25

When would a patient want to be on an iron supplement of some kind

Answer 25

When the TSAT is less than 30% and ferritin is less than 500

Question 26

What is serum iron

Answer 26

Concentration of iron bound to transferrin

Question 27

What is the total iron binding capactiy (TBIC), what level should it be at to get a more accurate TSAT

Answer 27

Capacity of the blood to bind iron with transferrin, greater than 200

Question 28

What is the equation to solve for TSAT

Answer 28

(serum FE/TBIC) X 100

Question 29

T/F: Looking at Ferritin levels is reliable in knowing if a patient has iron overload or anemia

Answer 29

False: Ferritin is an acute phase reactant that is elevated inifections or inflammatory states that can reach the thousands

Question 30

What are the oral iron supplements

Answer 30

ferrous sulfate, ferrous gluconate, ferrous fumarate, polysacchardie iron complex, carbonyl iron

Question 31

What oral iron supplement is the most popular, has the least absorbtion

Answer 31

ferrous sulfonate, ferrous gluconate

Question 32

How much elemental iron should patients receive a day, how should patients take their supplements

Answer 32

200 mg, start with one tablet per day and then work up to three tablets daily

Question 33

T/F: Iron can upset the stomach and therefore should be taken with food

Answer 33

False: Iron is best absorbed when it is not taken with food

Question 34

What are the side effects of taking iron

Answer 34

Fecal discoloration, nausea and vomiting, diarrhea or constipation

Question 35

T/F: The only CKD patients who use oral iron are usually stage 3-5 and are non-dialysis or perionteal dialysis

Answer 35

True

Question 36

What phosphorous binder can be used to also increase iron and can be taken with foods

Answer 36

Ferric Citrate (Auryxia)

Question 37

What drugs can decrease iron absorption

Answer 37

PPIs and H2RAs, cholestryramine, antacids, calcium

Question 38

What drugs will be affected by iron

Answer 38

Levothyroxine, fluoroquinolones, mycophenolate

Question 39

What medications are affected by iron and decrease absorption of iron

Answer 39

Tetracycline and doxycycline

Question 40

When a patient has severely low iron how much IV is given for a bolus

Answer 40

1 gram total

Question 41

T/F: IV iron is not given during a infection

Answer 41

True

Question 42

What are the 5 IV iron formulations

Answer 42

Sodium Ferric Gluconate, Iron Sucrose, Iron Dextran, Ferumoxtyol, Ferric Carboxymaltose

Question 43

Which IV iron formulations can possibly cause an anaphylactic reaction and must give a test dose

Answer 43

Iron dextran and Ferumoxtyol

Question 44

Which IV iron formulation is not approved for dialysis use but is given to patients in late stages of CKD

Answer 44

Ferric Carboxymaltose

Question 45

Out of the 5 IV iron formulations which one must be given IVPB and must be diluted and infused over a minimum of 15 minutes

Answer 45

Ferumoxtyol

Question 46

Out of the 5 IV fromulations which one can be given IM

Answer 46

Iron dextran

Question 47

What iron compound is added to a dialysis solution (hemodialysis only)

Answer 47

Ferric pyrophophate citrate (Triferic)

Question 48

What is a common side effect of IV iron

Answer 48

Hypotension

Question 49

T/F: High MMA is specific for B12 deficiency

Answer 49

True